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San Francisco nutritionist Karyn Duggan sees it all the time: patients come in confused, frustrated, and defeated. They’ve played by the rules and abided by the diet industry’s oft-repeated mantra: “eat less, move more.” Yet they’re unhealthy, unhappy, and still overweight.

“So many people try to fix their lives with weight loss and think, ‘everything is going to be fine once I’ve lost weight,'” says Duggan, who works with One Medical Group. “But sustainable weight loss should be a byproduct of feeling healthy and well.”

Since 2004, The Biggest Loser has captivated television audiences with stories of men and women who drop astonishing amounts of weight over the course of a season. Through restrictive diets and extreme workouts, overweight and obese contestants compete to shed pounds and in the end, “the biggest loser” wins it all.

Or do they?

The Truth Behind the Biggest Loser’s Supposed Success Stories

According to a recent study recapped in The New York Times, these apparent successes are usually fleeting. Researchers tracked 14 of the show’s contestants and found that over six years, 13 regained the weight they’d lost — four even became heavier than they’d been before the competition. The participants’ resting metabolic rates (RMRs) had slowed drastically and their bodies failed to burn enough calories to maintain their weights. Over the years, their metabolisms had not only failed to recover — they’d gotten slower.

RMR is the rate at which your body burns energy while at complete rest. “Imagine you spend an entire day sitting on the couch doing nothing but breathing and existing,” Chicago physician assistant Desmond Watt explains. “Despite your lack of activity or effort, your body would still burn a bunch of calories due to your underlying machinery needing energy to work. That’s your RMR and it’s influenced by a lot of variables like age, gender, height, and weight.”

So the number on the scale isn’t necessarily a direct result of calorie intake or miles logged. In fact, extreme measures can actually backfire — permanently. “The study found that such dramatic swings in weight can have huge impacts on RMR and can ultimately make ongoing weight management even more challenging,” Watt says.

For Duggan, the study justifies what she’s long known. “When I saw The New York Times piece, I thought it may have put the nail in the coffin for the ‘calories in, calories out’ argument,” she says. “Calories are only part of the picture — it’s like picking your husband based on height alone!”

While the study was small and lacked a control group, David Ludwig, a Harvard Medical School pediatrician and endocrinologist, says the results make sense: “This is a subset of the most successful dieters,” he said. “If they don’t show a return to normal in metabolism, what hope is there for the rest of us?” Ludwig says these results underscore the need for alternative approaches to weight loss.

5 Ways to Maintain Your Ideal Weight

While it may not make for compelling TV, when done in a healthy way, weight loss can be pain-free and sustainable. Here are our experts’ top tips for maintaining your ideal weight:

1. See the big picture.

“There are millions of ways to lose weight, but if you’re not feeling healthy, then whatever you’re doing is not going to be sustainable,” Duggan says. “It’s important to look at what’s going on with your sleep, exercise, etc. I have a patient — and this is going to sound cheesy — but I feel that self-love is missing from his diet.” Prioritize the parts of your life that matter most to your health and happiness.

2. Choose to make a lifestyle change, not to “start a diet.”

Nutritious foods and regular exercise are important elements of a healthy lifestyle, but Raheli Kory, a dietitian with the Rise nutrition coaching app, says approaching those things with a diet mentality isn’t the way to go. “I’m not saying you need to eat baby carrots and run 10Ks every week, but making small changes you can sustain long-term will help you live a healthier, happier, more energized life — all while maintaining your goal weight.”

Healthy weight loss is half a pound to one pound per week. “Anything beyond that is mostly water,” Kory says. “Losing weight faster than that can slow your metabolism.” Instead, set small goals that you’re more likely to achieve and that are more likely to set you up for long term success.

3. Adopt a realistic exercise routine.

The Biggest Loser contestants exercised for seven hours a day to lose weight. “Going from zero to 60 with exercise is unsustainable and will more than likely lead to over exhaustion, frustration, and ultimately leave you feeling burnt out and defeated,” Kory says. “Make small changes you can commit to and increase them slowly over time.”

Duggan believes pleasure should play a part too. “I don’t want my patients forcing themselves to run to lose weight — I want them to run because they want to,” she says. “Exercise is amazing, but if you’re approaching it with dread, it can lead to everything from stress to extreme injury.” Instead, find a form of movement you love and start incorporating small increments into your day.

4. Don’t skip meals — instead, use moderation.

Inevitable hunger pangs often lead to poor food choices. “To prevent sugar cravings, eat something every three to four hours,” Kory says. Between meals, she recommends snacks that balance protein, carbohydrates, and healthy fat, like apple with nut butter. “You can have your cake and eat it too…just in moderation,” she says, suggesting dieters incorporate small portions of ‘guilty’ pleasures in order to avoid binges. “That means wine, beer, pizza, and cookies can all make it into your diet every now and then as long as the rest of your meals are balanced.”

5. Surround yourself with support to stay accountable.

It’s easier to make major changes when you have a team behind you. Including friends and family in your journey can make a difference too. “Accountability is one of the most powerful tools out there, so take advantage of it,” Kory says. “Whether it means working out with a personal trainer or meeting with a dietitian, knowing someone is counting on you to stay committed to your goals is the best motivation you can get!”

Any general advice posted on our blog, website, or app is for informational purposes only and is not intended to replace or substitute for any medical or other advice. The One Medical Group entities and 1Life Healthcare, Inc. make no representations or warranties and expressly disclaim any and all liability concerning any treatment, action by, or effect on any person following the general information offered or provided within or through the blog, website, or app. If you have specific concerns or a situation arises in which you require medical advice, you should consult with an appropriately trained and qualified medical services provider.